Healthcare Provider Details

I. General information

NPI: 1548669294
Provider Name (Legal Business Name): VALENCIA FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3472 STATE HIGHWAY 47
LOS LUNAS NM
87031-8222
US

IV. Provider business mailing address

PO BOX 1298
LOS LUNAS NM
87031-1298
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-9788
  • Fax: 505-565-0422
Mailing address:
  • Phone: 505-865-9788
  • Fax: 505-565-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC M SMITH
Title or Position: OWNER
Credential: DDS
Phone: 505-865-9788